Measurement of blood and hair magnesium levels.IgG blood tests (for prescription of diet).Hair analysis (see CPB 0300 - Hair Analysis).Functional near-infrared spectroscopy (fNIRS).Event-related potentials (see CPB 0181 - Evoked Potential Studies).Evaluation of iron status (e.g., measurement of serum iron and ferritin levels).Electronystagmography (in the absence of symptoms of vertigo or balance dysfunction).EEG theta/beta power ratio for the diagnosis of attention deficit hyperactivity disorder.Education and achievement testing Footnote1*.Computerized tests of attention and vigilance (continuous performance tests) (eg, Gordon Diagnostic System).Computerized EEG (brain mapping or neurometrics (see CPB 0221 - Quantitative EEG (Brain Mapping)). Actometer/Actigraph (see CPB 0710 - Actigraphy and Accelerometry).Aetna considers pharmacotherapy and behavioral modification medically necessary for treatment of ADHD Footnote1*.Īetna considers the following experimental and investigational for the assessment and treatment of ADHD because the peer-reviewed medical literature does not support the use of these procedures/services for this indication.Referral to an outpatient mental health or chemical dependency provider may be medically necessary for the evaluation and comprehensive bio-psychosocial treatment for these disorders in collaboration with primary care physicians and other specialists. See CPB 0158 - Neuropsychological and Psychological Testing. In addition, neuropsychological or psychological testing performed solely for educational reasons may be excluded from coverage, as many Aetna benefit plans exclude coverage of educational testing please check benefit plan descriptions. Psychological testing is not considered medically necessary for evaluation of children with uncomplicated cases of ADHD. Neuropsychological testing is not considered medically necessary for the clinical evaluation of persons with uncomplicated cases of ADHD. In addition, neuropsychological testing is considered medically necessary to distinguish ADHD from learning disabilities or language/communication disorders when such distinction remains unclear after history and examination. Neuropsychological testing may be medically necessary in neurologically complicated cases of ADHD (e.g., post head trauma, seizures). Thyroid hormone levels if individual exhibits clinical manifestations of hyperthyroidism (e.g., modest acceleration of linear growth and epiphyseal maturation, weight loss or failure to gain weight, excessive retraction of the eyelids causing lid lag and stare, diffuse goiter, tachycardia and increased cardiac output, increased gastrointestinal motility, tremor, hyperreflexia).Parent/child interview, or if adult, patient interview which may include obtaining information about the individual’s daycare, school or work functioning utilizing the criteria listed in the DSM-5 may also include an evaluation of comorbid psychiatric disorders and review of the individual’s family and social history.Medical evaluation (complete medical history and physical examination).Measurement of blood lead level for individuals with risk factors.Laboratory evaluation (complete blood count, liver function tests ) and a cardiac evaluation and screening incorporating an electrocardiogram (ECG) if indicated, prior to beginning stimulant medication therapy.Electroencephalography (EEG) or neurological consult when the presence of focal signs or clinical findings are suggestive of a seizure disorder or a degenerative neurological condition.Complete psychiatric evaluation (adults).This Clinical Policy Bulletin addresses attention deficit hyperactivity disorder (ADHD).Īetna considers certain services medically necessary for the assessment of attention deficit hyperactivity disorder (ADHD): Number: 0426 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References
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